Fetal Bladder Catheterization in Severe Obstructive Uropathy before the 24th Week of Pregnancy

Abstract

Objective: Fetal obstructive uropathy is simple to diagnose before the 24th week of life. Drainage of the pathologically enlarged fetal bladder avoids development of hydronephrosis and destruction of kidneys and, obviously, prevents development of secondary oligohydramnios and pulmonary hypoplasia. The aim of our study was to evaluate the usefulness of a fetal bladder shunt in cases of obstructive uropathy before the 24th week of gestation. Methods: From January 1997 we diagnosed 6 cases of fetal obstructive uropathy before the 24th week of gestation. In all cases oligohydramnios or ahydramnios was also observed. After evaluation of the renal function on the basis of fetal urine samples, we shunted 5 fetuses. After routine preparation of the operative field, a special puncture needle was inserted through the abdominal wall of mother and fetus into the fetal bladder. Through the needle a fetal bladder catheter was inserted between the fetal bladder and the amniotic sac. After shunt placement, fetal urine fills the amniotic sac and the fetal bladder is decompressed. After the procedure, the patients were hospitalized and serial sonographic examinations were performed to evaluate shunt function. Bladder size, presence and size of hydronephrosis, and volume of amniotic fluid were evaluated. Results: The Rocket Medical catheters have an excellent ‘shape memory’. All but 1 newborns had a good perinatal outcome. Mean Apgar score was 8 at 1 min, weight at delivery was between 1,700 and 3,100 g. No pulmonary hypoplasia was observed. All deliveries were after the 33rd week of gestation (range 33–38 weeks). The minimum drainage time was11 weeks, maximum 18 weeks. In 2 cases premature delivery occurred because of premature rupture of the membranes. One newborn died of respiratory distress syndrome. Conclusions: Early bladder drainage (before the 24th week of gestation) enables delivery of newborns with a good perinatal outcome, without pulmonary hypoplasia. This method of therapy limits renal damage and allows time for normal development of the fetal lungs.

Systematic review of the effectiveness of antenatal intervention for the treatment of congenital lower urinary tract obstruction

“…[15][16][17][18] We therefore included the largest and most complete data set in meta-analyses, 17 which gave a total of 20 articles with a total of 369 fetuses eligible for inclusion in the meta-analysis. 1,6,7,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] This gave 16 additional studies and 232 additional fetuses from the previous meta-analysis. 8 A funnel plot was constructed to explore for publication bias.…”

“…There were 23 primary articles that met the selection criteria (Table S1); however, after contact with the authors it was apparent that there was significant overlap in the population in four of these studies 15–18 . We therefore included the largest and most complete data set in meta‐analyses, 17 which gave a total of 20 articles with a total of 369 fetuses eligible for inclusion in the meta‐analysis 1,6,7,19–34 . This gave 16 additional studies and 232 additional fetuses from the previous meta‐analysis 8 .…”

Transient Urinary Ascites after Vesicocentesis Observed in a Fetus with Megacystis Caused by Posterior Urethral Valve

“…The presence of oligohydramnios is frequently associated with bladder outlet obstruction and its observation is a sign of poor prognosis [5,6] . The effect of vesicoamniotic shunting has already been described in many previous studies [7][8][9][10] . Such intervention is usually performed in selected cases when other anomalies or chromosomal abnormalities have been excluded, when severe oligohydramnios has been noted, and when fetal renal function has been preserved.…”

The effects of overcoming experimental bladder outflow obstruction in fetal sheep

“…These interventions have included invasive treatments such as needle aspiration of the fetal bladder for decompression, or insertion of tubes (shunts) into the fetal bladder or kidney [8][9][10][11] , to allow continuous emptying of the bladder contents into the amniotic fluid. Open [12][13][14] and endoscopic 8,15-18 fetal surgical techniques have been attempted, either to break down the membranous obstruction or to create another opening in the bladder (vesicostomy).…”